Question:

How does CMS define a “group” test?

Answer:

Group tests are panels or profiles (sometimes referred to as order entry panels) that result in the billing of multiple CPT® codes. Reference labs generally have all components of panels and profiles listed in their catalogs. Unfortunately, the catalogs can become outdated quickly, so be sure to check with your reference lab to validate the codes. If you bill Medicare for a code, then you are liable— not the reference lab—even if it had the incorrect code printed in its catalog.


CPT® is a registered trademark of the American Medical Association.

This question was answered in the 2018 edition of our Coding Essentials for Laboratories. For more hot topics relating to laboratory services, please view our store, or call us at 1.800.252.1578 ext. 2.

 

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.